Appraisal of Nurse-Patient Relationships within the Coronary Care Unit - Coursework Example

Appraisal of nurse-patient relationships within the coronary care unit xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Course xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Instructor xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Table of Contents Table of Contents 1 1.0 Abstract 2 2.0Introduction 3 3.0 The Nurse-Patient Relationship 3 3.1 Trust 4 3.2 Power 5 3.3 Respect 5 3.4 Empathy 5 3.5 Professional Intimacy 6 4.0 Understanding Interpersonal Relationships 6 4.1 Personal Relationships 7 4.1.1 Casual Relationships 7 4.1.2 Friendships 7 4.1.3 Romantic or Sexual Relationships 7 4.2 Professional Relationships 8 4.2.1 Self-reflection 8 4.2.2 Following the care plan: 8 4.2.3 Meeting personal needs outside the relationship 9 4.2.3 Sensitivity to context 9 4.2.4 Termination of relationship 9 4.3 Phases in Nurse-Patient Relationship 10 4.4 Phases of interpersonal relationships 11 4.4.1 Orientation phase 11 4.4.2 Identification Phase 12 4.4.3 Exploitation phase 12 4.4.4 Resolution phase 13 4.5 Principles Underlying Professional Practice 13 5.0 Professional Boundaries 14 5.1 Acceptable behavior 14 6.0 Aspects for Future Developments 16 7.0 Conclusion 17 8.0 References 18 1.0 Abstract A therapeutic relationship with the patient in nursing is the essence of professional nursing (McCormack, 1997). Nurses are professionally responsible to understand the dynamics of the professional and therapeutic nurse-patient relationship. They are also required to create the relationship and to maintain it within professional boundaries. The 5 components of the nurse-patient relationship that ought to be present in every such relationship are power, trust, respect, empathy and intimacy. The main attribute in coronary care is the constant observation of the cardiac rhythm by means of electrocardiography or the existence of telemetry. Patients in the coronary care units therefore require a lot of continuous care and high levels of professionalism. Professionalism is also vital in the establishment and maintenance of nurse-patient relationships. The College of Registered Nurses of British Columbia (CRNBC) standards of practice offer direction and summarize the minimum expectations for nursing professionals in practice. There is a distinct difference between personal and professional relationships. A professional relationship, in this case the nurse-patient relationship, is regulated by a nurse’s code of ethics and professional standards while personal relationships are guided by personal values and beliefs. This and other factors make it difficult for a nurse and patient to have personal relationships. Quality of care is of supreme significance to both patients and nurses (Hakesley-Brown & R, 2007).  This paper also tries to illustrate aspects for future development in the field of coronary care giving and nursing in general. . 2.0 Introduction A coronary care unit (CCU) is a specialized hospital or a specialized ward within a hospital for treatment and care of heart attack patients or any other cardiac conditions that necessitate constant observation and treatment. It is also referred to as cardiac intensive care unit (CICU). It is a facility with a highly skilled staff that offers nonstop best possible care for patients with potentially acute cardiac conditions (Meltzer, Pinneo, & Kitchell, 1983).  In nursing, the professionals are required to have therapeutic relationships with the patients. This type of nurse-patient relationship is present to meet the requirements of the patient and to ensure that these requirements are primary. This is particularly essential in the coronary care unit because the patients require a lot of empathy and specialized care as well as fostering of hope so as to manage their illnesses (Wiseman, 1996). 3.0 The Nurse-Patient Relationship It is essential that the Nurse-Patient Relationship is professional and therapeutic. This ensures that the patient’s needs come first (Haugh & Paul, 2008). This professional relationship has several goals. The nurse aids the patient in coping with his or her illness and as well as helping the patient to realize and understand them. The nurse also plays an active role in ensuring the patients active participation in the treatment process. This works hand in hand with the identification of up-and-coming problems. The nurse also assists the patients in choosing and trying out new behavior patterns that would help against future attacks of the same problem. The patient usually has trouble finding meaning to his or her illness and the nurse is always at hand to help with that and also with communication constraints (Travelbee & Doona, 2010). A nurse should be on the lookout for all forms of communication ranging from non-verbal to verbal. Non-verbal communication is affected by several factors that include proxemics, the physical space between the sender and receiver; kinetic, body movements such as facial expressions, gestures and mannerisms; touch, a physical intimate contact; silence; and paralanguage, this pertains to voice quality i.e. tone, inflection or how the communication is delivered (May, 1992). This Nurse-Patient Relationship contains five major components (Fawcett, 1997). These are trust, power, respect, empathy and professional intimacy. These components are constantly there in spite of the circumstance, duration of interaction and whether the professional is the primary or secondary care provider. 3.1 Trust The patients anticipate that the nursing professionals have the essential knowledge and skills to attend to them competently. The patient is in a vulnerable situation and therefore trust is very important in this relationship. Nurses are expected to exhibit compassionate attitudes and conduct and consequently the patients can entrust their care to them (Johns, 1996). At the outset, trust in any relationship is frail, so it’s particularly imperative that a care giver keep promises to a patient (Fontes, 2005). Reinstating breached trust can be very difficult and so it is essential that the nurse works hard at maintaining it. 3.2 Power The nurse-patient relationship is one of imbalanced power. The professional possesses more power than the patient. This is because the nurse has more clout and influence in the health care system not to mention specialized skills and right to access and use privileged information pertaining to health care (Shattell, Hogan, & Thomas, 2005). The correct use of the authority that the nurse commands, in a helpful way, enables harmonious partnerships and focus on the patient’s needs. 3.3 Respect Respect encompasses the acknowledgment of the intrinsic dignity, worth and individuality of every person. This is basic to the Nurse-Patient Relationship. The professional needs to be acquainted with and comprehend the culture and other aspects of the patient’s personality and to take these into consideration when providing care (Macleod, 1994). Respect entails being non-judgmental of the patient not considering the socio-economic standing, individual traits and the nature of the health predicament. 3.4 Empathy Empathy is defined as the expression of understanding, certifying and resonating with the connotation that the health care practice holds for the patient (Kunyk & Olson, 2001). In the nursing practice, empathy includes appropriate emotional detachment from the patient to guarantee impartiality and a fitting professional response (Hope & Webb, 1995). 3.5 Professional Intimacy Professional Intimacy is inbuilt in the type of care and services that nursing professionals provide. It relates to the variety of activities that nurses carry out for and/or with the patient that generate individual and private intimacy on many levels. This may relate to the physical deeds, for instance bathing, that the professionals perform for, and with, the patient that create closeness. Professional intimacy can involve physical, emotional, social and spiritual elements. The nurses’ authority to access the patient’s personal information is also a contributing factor to professional intimacy. 4.0 Understanding Interpersonal Relationships Interpersonal relationships are natural in exchanges among people, which of course include health care providers, and may be categorized as personal or professional. Personal relationships can be further categorized into platonic friendship, casual acquaintances, or a romantic (sexual) relationship. The College of Registered Nurses of British Columbia (CRNBC) standards of practice offer direction and summarize the minimum expectations for nursing professionals in practice. The nurse-patient relationship is a distinctive professional relationship instituted to address the needs of the patient. A nurse has the responsibility to set up and sustain the Nurse-Patient Relationship in a professional manner so as to maintain adequate objectivity in the care provided (Williams & Iruita, 2004). 4.1 Personal Relationships 4.1.1 Casual Relationships These types of relationships arise when nurses, as affiliates of a society, are acquainted with other individuals that are not part of the said society or community. A casual relationship is not considered as close, romantic or sexual in nature. 4.1.2 Friendships Friendships also referred to as platonic relationships can exist between a nursing professional and a patient, a patient’s significant other or both, outside of the nurse-patient relationship. This is a close bond which may encompass a significant meaning and history for every person involved. Nurses should not become involved in friendships with patients, but they may possibly have a pre-existing acquaintance with an individual who becomes a patient. This is a non physical relationship which is not regarded as romantic or sexual. 4.1.3 Romantic or Sexual Relationships A sexual relationship involves erotic desires and/or activities. On the other hand, a romantic relationship by and large entails both sexual and emotional intimacy. These two types of relationships with patients are unprofessional, unprincipled and unethical. In practice, they have a high probability of harmful consequences to the patient (shanttell, 2004). In light of this, the nursing code of conduct prohibits nurses from engaging in romantic or sexual relationships although they may have a relationship with an individual which existed before he/she becomes a patient. 4.2 Professional Relationships professional relationships between nurses and their patients is based on a acknowledgment that are in the greatest position to come up with decisions about their own lives and health when they are active and clued-up partaker in the decision-making process (Williams & Iruita, Therapeutic and non-therapeutic interpersonal interactions: the patients perspective, 2004). In cardiac patients, this is usually done by alternate decision-makers due to the severity of some of the cases. These relationships should have a positive consequence on meeting a patient’s remedial needs and in all ways possible ensure that the patient receives safe, proficient and ethical care (College and Association of Registered Nurses of Alberta, 2005). It can be very difficult to maintain boundaries in professional relationships especially in cardiac patients who require a lot of personal care. The nurse has a responsibility to set the boundaries. This is done by: 4.2.1 Self-reflection This is achieved (Paavillainen & Astedt-Kurki, 1997) if the nurse continuously reflects on own interactions with patients and on own personal needs and emotions. All the characteristics of the nurse impact on the interaction the nurse has with the patient. Through reflection therefore enables the nurse to comprehend and find out how own personal attributes can influence the relationship. 4.2.2 Following the care plan: It is vital that the nurse establishes and develops an all-inclusive plan of care with the patient and the alternate decision makers who act on behalf of the patient as well as with other associates of the health team. The plan offers direction and regulation on the subject of boundaries of the Nurse-Patient relationship and the requirements best suited to meet the patient’s needs (S.Wright, 2005). The developed plans should not cross boundaries as they are strategies that are meant to meet the patient’s restorative needs and to smooth the progress of the patient’s short and long-term goals. 4.2.3 Meeting personal needs outside the relationship The nursing professional is required to be aware of the nature and restrictions of the therapeutic relationships and therefore meet personal needs outside the relationship. This kind of relationship differs from a social relationship since the requirements of the patient always come first. Although nurses have more power in the relationship, they are prohibited to use these powers to meet their personal needs (Smith, Taylor, Keys, & Gornto, 1997). In light of the nature of the nurse-patient relationship, it is impractical to sustain a therapeutic as well as a social relationship with the patient at the same time. 4.2.3 Sensitivity to context A nurse is ethically supposed to be sensitive to the situation in which nursing care is provided. The patient’s home for instance may feel like a casual atmosphere in which to provide care, this often makes the boundary between professional nurse-patient and social relationships vague. This may in turn lead to temptation by the care giver to do more for a patient who is short of social support (Rushton, Armstrong, & McEnhill, 1996). 4.2.4 Termination of relationship Initiating, maintaining and ending the nurse-patient relationship appropriately are a key skill in the nursing professional. The relationships established between the patient, the alternate decision makers who can be friends and family and the health team has an expiry date (Scopelliti, Judd, Grigg, Fraser, & Hulbert, 2004). The health-related objectives and needs of the patient dictate when the relationship will terminate. 4.3 Phases in Nurse-Patient Relationship The model of nurse-patient relationship was first introduced by an American nurse (Peplau, 1952). The theory sets out to explain that the function of nursing is to assist others recognize their felt difficulties. The model highlights the interpersonal developments and therapeutic relationships that build up between the nursing professional and the patient. Peplau defined nursing as an interpersonal healing art that assists an individual who is in need of health care or is unwell. This theory outlines the various roles of nurses which include: Teacher: the nurse is expected to impart knowledge in reference to the patients need or interest. This is a basic nursing role as the patients are usually clueless as to their ailments especially with coronary patients. Leader: the professional helps the patient assume utmost accountability for meeting treatment objectives in a reciprocally satisfying way. Stranger: the nurse receives the patient in the same manner that one would meet a stranger in the ordinary life situation. The nurses’ duty is to provide a tolerant climate that builds trust. Resource person: a patient generally requires therapeutic care because of a new problem or situation that arises. The nurse is far more knowledgeable in this field and therefore provides the specific information that the patient needs in regards to their situation. Counselor: the nurse has a duty to provide guidance and encouragement to the patient. With the new circumstances that the patient faces, he or she needs help in understanding and integrating the meaning into their lives. Surrogate: apart from working on the patients’ behalf as an advocate, the nurse assists in clarifying and differentiating areas of dependence from interdependence and independence. The above summarize the main roles but additional roles may include tutor, consultant, technical expert, researcher, recorder, administrator, observer, socializing agent and safety agent. 4.4 Phases of interpersonal relationships There are four main phases in the nurse-patient relationship: orientation phase; identification phase; exploitation phase; and resolution phase (Simpson, 1991). 4.4.1 Orientation phase This phase is also referred to as the problem defining phase. It starts when the nurse and the patient first meet as strangers because of the patients need. This phase starts with defining the problem and making a decision as to what kind of service required. At this stage, the patient communicates his or her needs and seeks assistance from the care giver. The patient asks questions and shares expectations. The nurse in effect helps identify the problem and assists in the use of accessible resources and services. There are several factors that influence this stage. Factors that are common to both the care giver and the patient are values, culture, race, beliefs, past experiences and expectations. However, patients are influenced by preconceived ideas such as heart illnesses are always terminal. This takes us to the next phase (Arja, Leino-Kilpi, & Katajisto, 2008). At this stage, the nurse is continuously collecting data and analyzing it as part of the nursing process. This is the assessment stage in the nursing process and runs concurrently with the orientation phase. 4.4.2 Identification Phase With patients preconceptions in mind, professional assistance and the delivery of pertinent information should be done appropriately. At this stage, the patient is encouraged to actively participate in setting goals and this leads to selective responses to those who can solve the problem and thus meeting his or her needs. This gives the patient a sense of belonging and a potential of dealing with the problem which in effect decreases the feeling of despair and helplessness. As the patient is setting independent goals, the nurse is planning a diagnosis. The nurse’s goal at this stage is mutual as the needs of the patient come first. 4.4.3 Exploitation phase This stage entails the use of professional assistance to get problem solving options. Services are offered based on the patients needs and this makes him or her feel like an essential element of the helping environment. This stage allows for patient requests on issues that they feel should be addressed (Columbia, 2006). It is necessary to employ interview techniques so as to help in investigating, understanding and satisfactorily dealing with the causal problem. It is the nurse’s duty to help the patient exploit all avenues of assistance so that progress can be made. Communication is very essential in this phase and so nurses should be fully aware of any form that may reveal itself. At the same time, the nurse is now at the implementation stage. He or she initiates plans set at achieving the mutually set goals. This may be accomplished by the nurse, the patient or the alternative decision maker in serious cases. 4.4.4 Resolution phase This is the final phase of the process and leads to termination of the therapeutic nurse-patient relationship. At this stage, the patients needs have by now been met by the joint effort of patient and professional. This dictates that the professional relationship should be dissolved and both parties should go their separate ways. This is at times difficult for both parties but the bonds have to be broken. 4.5 Principles Underlying Professional Practice A nurse is supposed to be skilled In order to manage a therapeutic relationship. The relation is maintained by the nurse by applying his or her specialized nursing knowledge. There are principles involved in the professional practice which include; the nurse should always function by being guided by the standards for nursing practice, the nurse should always put boundaries when it comes to a client in spite of the desires of the client this is because the nurse will always be accountable for any outcome even the ones unintentional though foreseen (College and Association of Registered Nurses of Alberta, 2005). A therapeutic relationship is developed with the main reason of upholding the patient’s health and not to convene the desires of the nurse, the nurse should always hold In high opinion the patient personal distinctive traits like cultural and social character, sex, religious association or appearance, the nurses should also seek advice on the required knowledge and skill. In the therapeutic relationship from other affiliate of the health squad, the nurses ought not to be offensive towards patient and should always seek help when dealing with complicated patients. 5.0 Professional Boundaries A nurse may not realize that he or she has crossed some boundaries by spending too much time with one patient even beyond the patient’s requirements or even altering patient’s assignments in order to care for one particular patient. A nurse should also not reveal a patient’s private issues to other people. The relationship should be extremely confidential. Nurse should also be professional when it comes to dressing. A nurse is supposed to watch how he or she dresses especially when taking care of a patient (Smith, Taylor, Keys, & Gornto, 1997). The nurse-client relationship should not cross the professional line. The nurse may sometimes become over involved with a patient by always thinking of the patient even when not at work or being self-protective when questioned about his or her relationship with a patient. The nurse should also never spend off duty time with a patient, this is more than required. The nurse should by no means keep secrets with a patient from other health colleagues or even offer a patient his or her personal phone number. It is important that the nurses observe the rules and regulations set by the agency when taking care of a patient. If a nurse believes that boundaries have been tempered with in any situation, he or she should take the required action to seek that issue (Columbia, 2006). 5.1 Acceptable behavior A nurse can be allowed to reveal personal information to a patient if the information helps in attainment of the therapeutic needs of a patient. The information may contain private experiences that have effectively been resolved. However the nurse should always be careful when disclosing personal problems since the patient might feel neglected or sense that his problems are been left out. If the disclosure is done improperly, it might meddle with the nurse capability to meet the patient’s needs. Issues of accepting gifts from patients have always been complicated. The nurse needs to comprehend why the patient is offering the gifts. It could be that it is the patient’s cultural values to offer gifts to people caring for them and dismissal of those gifts might offend the patient. The nurse in preserving the nurse-client relationship must also not solicit gifts from patients. There are things that nurses need to reflect on when deciding whether to accept a gift or not (shanttell, 2004). They include; the rules and regulations of the organization where the nurse is employed, the scenario In which the gift is been offered and the reasons behind the gift, the appropriateness and the financial value of the gift, the rationale of the patient in presenting that gift, whether the patient might now demand more special care because of the gift or feel compelled to offer gifts to other members of the health team. There are situations where nurses can offer gifts to patients especially those patients with no close relatives or during their birthdays or any special occasion. However there are things to be considered which include; if the gift is part and process of therapeutic arrangement for the patient (Columbia, 2006). If the gift is provided from the organization or a certain group of nurses who cares for the patient, the nurse should ensure that the patient does not feel obligated to provide a gift in return, the gift should in no circumstances change the status of the relationship between the patient and the nurse and the gift should draw any negative feelings from other patients. There are situations where a nurse may be required to offer care to persons whom they have affiliations with. It could be friends, family or acquaintances. In such a scenario it is important to consider that; the patient needs to have accepted to be cared for by a person whom they have a close relation with, the nurse must ensure that their close relation with the patient does not interfere with their ability to provide care and meeting patient’s needs, the nurse should also ensure that the boundaries are not in whatever means crossed and confidentiality should also be maintained. There should be no information about the patient being revealed to other members of the family and friends even after the nurse-patient relationship ends (College and Association of Registered Nurses of Alberta, 2005). Nurses in some cases are allowed to use restraints when handling a patient. The restraints could be sued to protect the patient from harming himself or other patients. Restraint properly executed is not considered abuse. 6.0 Aspects for Future Developments In coronary cases, there are a huge number of fatal cases and therefore extra care needs to be taken in the management of these patients. However, there are mild cases that require a little less attention. For these few cases like the low-risk Myocardial infarction (MI) patients, medical practitioners should consider admitting them on telemetry directly to cardiac wards. This would set aside the coronary care beds to be readily available for the most critically ailing cardiac patients, in spite of the diagnosis. There is a shortage of beds reserved for coronary patients and therefore the medical professional’s needs to find a way to make the best use of them (Williams, Cooke, & May, Sociology, Nursing and Health, 1998). One way to do this is to develop and employ a risk stratification model when taking into consideration the accurate placement of patients suffering from acute coronary syndromes. This method has successfully worked in intensive care units and therefore the implementation is sure to bear positive results. Caregivers in the coronary care units need to pay more attention to the increasing dying patients’ health and care so as to improve practice. Improved support to patients and their alternate decision makers (be it family or friends) improving interaction and communication among the health care staff in the coronary unit will also play a big role in practice improvement. Good working relations ensure that the professionals offer the best support and care to their patients. 7.0 Conclusion Nurses who work in the coronary care unit should be highly motivated to offer the best possible care and to guarantee a dignified death for their critical patients in case it comes to that. Therapeutic relationships are compulsory in the nursing profession and therefore nurses have to undergo training so as to be conversant with the requirements (Department of Health, 2000). Nurses should ensure privacy when providing care and ensure that all the basic needs are met, as well as easing pain and all other sources of discomfort. The professional relationship between a patient and a nurse has several goals. The major characteristic though is that the nurse provides therapeutic care to the patient with the aim of fostering the healing process. The nurse-patient relationship is goal directed, the goal being provision of the best care to the patient. Although the nurse has more power in this relationship, the patient is the ultimate boss as his or her needs are put before those of the nurse. Abuse of this power in any way by the nurse has serious consequences (College of Physicians and Surgeons of British Columbia, 2006). 8.0 References Arja, S., Leino-Kilpi, H., & Katajisto, J. (2008). Factors related to the nursing student-patient relationship: The students perspective. Nurse Education Today , 539-574. College and Association of Registered Nurses of Alberta. (2005). Professional boundaries for registered nurses: guidelines for the nurse-client relationship. Edmonton: Available online: www.nurses.ab.ca. College of Physicians and Surgeons of British Columbia. (2006). Sexual boundaries in the physician/patient relationship. Vancouver: Available online: www.cpsbc.ca. Columbia, C. o. (2006). Nurse-client relationships. Vancouver: Available online: www.crnbc.ca. Department of Health. (2000). The NHS Plan: Creating a 21 st Century NHS. London: HSMO. Fawcett, J. (1997). Nursing as a Therapeutic activity: an ethnography. Philadelphia: J.A. Davis. Fontes, L. (2005). Interviewing Clients across Cultures. New York: Guildford. Hakesley-Brown, & R, M. (2007). Patients and Nurses: A Powerful Force. OJIN: The Online Journal of Issues in Nursing. Vol. 12 , 54-63. Haugh, S., & Paul, S. (2008). The Therapeutic Relationship. Ross-on-Wye: PCCS Books. Hope, K., & Webb, C. (1995). What kind of nurses do patients want? Journal of clinical nursing , 101-108. Johns, J. (1996). A concept Analysis of trust. Journal of Advanced Nursing , 76-83. Kunyk, D., & Olson, J. (2001). Clarification of conceptualizations of empathy. Journal of Advanced Nursing , 317-325. Macleod, M. (1994). It's the Little Things that Count: the hidden complexity of everyday clinical. Journal of Clinical Nursing , 361-368. May, C. (1992). Individual Care? Power and subjectivity in Therapeutic Relationships. Sociology , 29-38. McCormack, B. (1997). Speaking for you or speaking for me: A values based approach to understanding autonomy when working with older adults. Vancouver. Meltzer, L., Pinneo, R., & Kitchell, J. (1983). Intensive Coronary Care. New York, NY: Robert J. Brady. Paavillainen, E., & Astedt-Kurki, P. (1997). The client-nurse relationship as experienced by public health nurses: Toward better collaboration. Public Health Nursing , 137-142. Peplau, H. (1952). Interpersonal Relations in Nursing. New York: Springer Publishing Company. Rushton, C., Armstrong, L., & McEnhill, M. (1996). Establishing therapeutic boundaries as patient advocates. Pediatric Nursing , 185-189. S.Wright. (2005). Self Discovery. Nursing Standard , 14-15. Scopelliti, J., Judd, F., Grigg, M., Fraser, G., & Hulbert, C. (2004). Dual relationships in mental health practice: Issues for clinicians in rural settings. Australian and New Zealand Journal of Psychiatry , 953-959. shanttell, M. (2004). Nurse-Patient Interaction: a review of the Literature. Journal of Clinical Nursing , 714-722. Shattell, M., Hogan, B., & Thomas, S. (2005). Nurse-Patient Interaction: a review of the Literature. Journal of Clinical Nursing , 159-169. Simpson, H. (1991). Peplau-Model in Action. Toronto: Macmillan Press. Smith, L., Taylor, B., Keys, A., & Gornto, S. (1997). Nurse-patient boundaries: Crossing. American Journal of Nursing the line , 26-32. Travelbee, J., & Doona, M. E. (2010). Intervention in Psychiatric Nursing: A One-To-One Relationship. New York: Springer Publishing Company. Williams, A., & Iruita, V. (2004). Therapeutic and non-therapeutic interpersonal interactions: the patients perspective. Journal for clinical Nursing , 806-815. Williams, A., Cooke, H., & May, H. (1998). Sociology, Nursing and Health. Butterworth UK. Wiseman, T. (1996). A concept analysis of empathy. Journal of Advanced Nursing , 1162-1167. Read More